As more babies are born in Alberta suffering from symptoms of withdrawal as a result of exposure to opioids in the womb, the Canadian Paediatric Society has issued new guidelines for the treatment and support of newborns affected by maternal drug use.

There has been a 74-per-cent increase in the number of babies hospitalized in Alberta due to neonatal abstinence syndrome (NAS), according to data gathered by the Canadian Institute for Health Information (CIHI) over the past five years.

In 2016-17, there were 207 hospitalizations in Alberta for acute NAS — a little more than half of those hospitalizations occurred in Calgary or southern Alberta, up from around 119 in 2012-13.

Not all cases of NAS are caused by illicit drug use, but health officials say illicit opioids are fuelling the increasing numbers, along with prescription opioids and drugs used in substance-use therapy.

The executive director for the Calgary Pregnancy Care Centre, a non-profit that assists pregnant women and mothers in crisis, says there are a number of reasons that some pregnant women continue taking drugs that may be harmful to their unborn child.

Some women may be unaware of the harm some drugs may do to their child, others are fearful that their child may be taken from them if they disclose an addiction, said Jutta Wittmeier.

“A lot of women do really try, but some people are really stuck in the addiction,” Wittmeier said.

“And it can be shame, obviously. Everybody wants to do well by their child but sometimes it’s the survival response of a person who’s often had so much pain in their lives.”

A large proportion of NAS cases can be attributed to withdrawal from opioids such as oxycodone, hydromorphone and fentanyl. It can also occur in babies born to women in treatment for substance use who are taking methadone or Suboxone.

The society’s guidelines, released Thursday, advise that babies suffering with NAS and their mothers should room together in hospital when possible, rather than the baby being sent for treatment at a neonatal intensive-care unit, or NICU.

“Weeks of separation can be harmful to early bonding and attachment, and risks making a bad situation worse for both mothers and their babies,” said Dr. Thierry Lacaze, head of the neonatal program at the University of Calgary and primary author of the document.

“Keeping mothers and their infants together has been shown to lower NICU admissions, promote breastfeeding, shorten hospital stays and decrease the need for prescription drugs.”

Lacaze said babies typically begin experiencing withdrawal from in-utero exposure to the powerful narcotics within 12 to 24 hours after birth, exhibiting such symptoms as extreme irritability and problems with feeding and sleeping.

“In the worst-case scenario, those babies can even develop seizures,” he said.

About 50 to 75 per cent of infants born to women on opioids will need treatment for withdrawal. Traditionally, morphine has been used, with clinicians administering increasingly smaller doses over time until a baby is completely weaned off the replacement drug.

But having a rooming-in program that keeps mothers and babies together can significantly reduce the proportion of infants who need to be treated with morphine, as breastfeeding will provide a small amount of the drug, helping to control withdrawal symptoms, Lacaze said from Calgary.

“It’s really working during the first few hours after birth to ensure that breastfeeding starts to be established, that babies stay with mom skin-to-skin in a quiet environment,” he said. “And it’s really amazing — it works.

“There is no need for separation, there is no need for medication and, of course, there’s a huge impact on cost because those babies don’t have to go to the NICU.

Comments

We encourage all readers to share their views on our articles and blog posts. We are committed to maintaining a lively but civil forum for discussion, so we ask you to avoid personal attacks, and please keep your comments relevant and respectful. If you encounter a comment that is abusive, click the "X" in the upper right corner of the comment box to report spam or abuse. We are using Facebook commenting. Visit our FAQ page for more information.